Optimized differential diagnosis of breast lesions by combined B‐mode and color Doppler sonography

Abstract

To optimize the sensitivity and specificity of gray-scale imaging and color Doppler in breast tumor diagnosis, alone and in combination, 89 women with palpable breast masses were scanned preoperatively and standard parameters were determined in both modes. Parameters significant for differentiation of benign and malignant tumors identified using univariate analysis were combined and weighted using multivariate analysis (multiple logistic regression). Histologically 59 tumors were malignant and 30 benign. Gray-scale sonography alone achieved a sensitivity of 88% and a specificity of 96% using the parameters of wall structure and posterior acoustic attenuation. Color Doppler achieved a sensitivity of 85% and a specificity of 79% using resistance index and pulsatility index as parameters. Combination of both methods yielded an accurate diagnosis in 84/87 patients (sonographic lesion correlates were absent in two cases), equivalent to a sensitivity of 97% and a specificity of 96%. Thus the individual diagnostic performance of gray-scale imaging and color Doppler sonography in palpable breast disease is further enhanced using multiple logistic regression to combine independently significant parameters.

Adenomyoepithelioma of the breast.

“…These Doppler sonographic criteria, although not primary discriminating features, offer help in the differential diagnosis of solid breast masses identified on mammography and real-time sonography, because when taken together, they lead us to consider malignancy as a probability. [12][13][14][15][16] Rosen 11 stated that of the available mammograms of 5 cases, 3 were reported as suggestive of malignancy, 1 had a gradual increase in size detected over a 2-year follow-up, and 1 was reported as negative. In our case, initial frozen biopsy incorrectly suggested carcinoma, and histologic analysis was required for definitive diagnosis.…”

Role of B Mode in Evaluating Malignant Breast Masses

“…Sensitivity and specificity used in computing were 88% & 96%,were taken from literature. 6 Prevalence of breast cancer in the sample to be studied was assumed to be20% from data collected from hospital records. W was set as 0.20.…”

“…Spiculation has a very good positive predictive value but a low sensitivity. 4,5,6 Angular Margins: The presence of angular margins is especially valuable because it can occur in both spiculated and circumscribed malignant nodules. The angles on the surface of the solid nodule may be very acute, 90 degrees, or even obtuse.…”

Sonographie benigner und maligner Mammatumoren

“…Der Effekt hält nur wenige Minuten an. Bisherige Studien zeigten für die FarbdopplerSonographie eine Sensitivität von 68-97 bei einer Spezifität von 64-96 für maligne Mammatumoren [9,17,18,21].…”

“…Sensitivität (%) Spezifität (%) Kotsianos [13] 92 81 Buchberger [16] 100 34 Marquet [16] 94 91 Blohmer [4] 95 80 Berg [3] Invasiv duktales Ca 94 Invasiv lobuläres Ca 86 DCIS 47 Schelling [18] 88 96…”